RESUMEN
Background Upper respiratory tract infections (URTIs) represent the most common diagnosis in ambulatory care settings. Some of these infections are properly treated with antibiotics, but evidence points to an inappropriate overuse of antibiotics in URTI management. This overuse is linked to antibiotic resistance, drug-related adverse effects, and increased costs. Objective This study evaluated the prevalence and predictors of antibiotic prescription for patients with URTI symptoms at the primary healthcare centers (PHCCs) and pediatric emergency department (ED) of the Maternity and Children Hospital (MCH) in Dammam, Saudi Arabia. Methods A prospective study was conducted in the PHCCs and pediatric ED of MCH. Trained physicians collected data on patients with URTI symptoms aged three years and older. Scores based on modified Centor criteria were calculated, and rapid antigen detection tests (RADTs) were conducted for all study participants. Results Out of 469 patients with a URTI, 141 (30.1%) received a prescription for an antibiotic, with a smaller proportion in the PHCCs (n=85; 24.4%) than in the pediatric ED (n=56; 46.3%). The main significant predictors of antibiotic prescription in terms of odds ratio (OR) and 95% confidence interval (95%CI) were a positive RADT result (OR=41.75, 95%CI=4.76-366.28), the presence of tonsillar exudate (OR=5.066, 95%CI=3.08-8.33), tender and/or swollen anterior cervical lymph nodes (OR=4.537, 95%CI=1.96-10.54), and fever (OR=3.519, 95%CI=2.33-5.31). A higher Centor score was also a predictor (2 to 5 vs. -1 to 1) (OR=2.72, 95%CI=1.8-4.12). The absence of a cough was not a significant predictor (OR=1.13, 95%CI=0.74-1.72). Conclusions Although a positive RADT increased the likelihood that a patient would be prescribed an antibiotic at the time of assessment, most antibiotic prescriptions were not justified. To control expenses, prevent adverse effects, and limit the spread of antibiotic resistance, efforts should be made to reduce unnecessarily high antibiotic usage.
RESUMEN
The causes of dysphonia or hoarseness are numerous and can be classified as functional or organic. The report will highlight the clinical presentation, histopathological features and management plan of laryngeal epidermal inclusion cysts (EICs). Laryngeal EICs are rare. The epidermal and dermoid cysts represent only 0.01% of oral cavity cysts. Their clinical presentation varies from a completely asymptomatic presentation to dysphonia for years. This current report represents a case of a 34-year-old female who presented with 2-year history of dysphonia, which was caused by a unilateral laryngeal EIC.
RESUMEN
Inflammatory fibroid polyps (IFPs), or Vanek's tumor, are rare benign mesenchymal lesions of the gastrointestinal tract (GIT). IFPs can be found throughout the GIT but most frequently in gastric antrum or ileum, with the appendix accounting for only <1% of all IFPs. The clinical presentation is usually vague yet depends on the location. We report a case of 50-year-old healthy male presented to the emergency department with a sub-acute complaint of non-specific abdominal pain, which was suspected to be appendicitis. Abdominal CT scan was done as well as colonoscopy and histopathology were scheduled. A week later, he presented in the clinic, still complaining of abdominal pain; thus, the decision was made to schedule him for laparoscopy with appendectomy. Finally, the post-operative course was unremarkable and the patient was discharged home. This is a rare case of IFPs originating in the appendix presenting as an atypical sub-acute appendicitis.
